Nursing Case Study on Bronchiolitis: Activities of Living, Nursing Care Plan and Evaluation

This nursing case study is based on the case of an 18-month old girl child suffering from bronchiolitis. The essay highlights the activities of living (AoL) in relation to high body temperature and breathing, nursing care plan and evaluation.

Nursing Case Study
Name of the Student
Name of the University
Author Note

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NURSING CASE STUDY
Introduction
Bronchiolitis is a type of lung infection which causes congestion and inflammation in
the bronchioles (small airways) of the lungs. The causative agent of bronchiolitis is virus
which is popularly known as respiratory syncytial virus (RSV) or pneumovirus. The main
target group of this inflammatory viral infection is young children and infants. The initial
symptoms of bronchiolitis might be confused with common cold as both of them share
common symptoms like running nose, sneezing, coughing and mild rise in body temperature.
However, in case of bronchiolitis, the conditions become serious after few days with the
appearance of symptoms like distinguishing coughing bouts. Moreover, paediatric
bronchiolitis is also characterised by high body temperature which leads to the generation of
several complications like seizures, haemorrhage or skin turning blue that might cause
permanent brain damage.
The following essay is based on the case study of 18-month old girl child, Bree and
will highlight the activities of living (AoL) in relation to high body temperature and
breathing. The essay will also frame nursing care plan of the child that will promote fast
recovery along with well-being.
Activities of Living (AoL)
Overview of AoL
Bronchiolitis among the paediatric patients is associated with high body temperature.
The rise in body temperature leads to fever (Ralston et al., 2014). As per the case study, Bree,
18-month old girl child was admitted to the paediatric ward with bronchiolitis and was
expressing symptoms like shortness of breath, expiratory wheeze, cough, runny nose with
oozing clear mucous and body temperature of 38.2 degree Celsius. By analysing these

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prevailing symptoms it can be said that her body temperature is few notch higher than normal
body temperature. According to Sloane et al. (2014), body temperature above 38 degree
Celsius is risk for infants and the condition is commonly known as Pyrexia. Pyrexia is
associated with complications like lethargy, dehydration and hyperalgesia. Lathergy
dehydration was hamper the health and well-being of the child and thus high body
temperature must be controlled on highest priority.
Breathing is an important activity of life which is crucial for sustaining. In
bronchiolitis coughing is frequently associated with vomiting, breathless and chocking due to
presence of mucus in the pulmonary airways. During cough associated with expiratory
wheeze and mucus, Bree’s pulmonary pathway might get obstructed resulting in breathing
blockage at the end of each coughing bout. This sudden cessation of breathing might turn the
child red or blue within very short span to time (Mecklin et al., 2014). If these conditions
continue for few days or week, it might lead to nausea, tiredness, sleep disturbances and
laboured breathing. All these in turn affect the quality of life of the infant.
AoL in relation to Bree and possible treatment
Body temperature is the ratio of total heat generated in the body and total heat loss.
Among the paediatric population, the primary symptom of bacterial and viral infection is
increase in body temperature which in turn is transformed into fever (Houdas, & Ring, 2013).
Normal body temperature of infant ranges in between 36.5 to 37.5 degree Celsius. The body
temperature is lowest during early hours in the morning which gradually increase and reaches
peak during late hours of afternoon or evening. Increase in body temperature from the normal
permissible limit increases discomfort among children (Houdas, & Ring, 2013). According to
the case study, Bree’s body temperature at the time of admission is 38.2 degree Celsius.
Under the action of inflammation, the hypothalamic point is raised and this causes
vasoconstriction and shutting of blood flow. Such mechanism causes decrease in body

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temperature partially due to lack of blood flow along with shivering (Houdas, & Ring, 2013).
Drop in body temperature will be associated with profuse sweating. This sweating might in
make Bree feel dehydrated. Common symptoms of dehydration among paediatric population
include dry mouth, lack of adequate urine or discharge of pale or yellow urine and
drowsiness. As Bree is only 18 months old, she is unable to express her concerns and
discomfort and thus proper fluid balance chart (input and output of fluid) is important to
document any signs of dehydration. It is the duty of the nursing professional to comprehend
and understand the problems and discomfort of Bree and this will help to frame for
assessment and care plan for Bree which is focused, competent and safe. Nursing
professional or the care giver must also note vital signs of Bree in a periodic manner in order
to highlight any signs of abnormality. At present, Bree has symptoms like expiratory wheeze,
runny nose with oozing clear mucous. Thus isolation in a single room will be best suited for
Bree. Single room isolation will help to prevent the spread of infection (Bekhof et al., 2013).
Since Bree is a new born child, liquid antibiotic will be suitable for her in order to reduce the
infection and body temperature but administration of medication can only be done under the
medication orders prescribed by the doctors. However, Hasegawa et al. (2013) are of the
opinion that antibiotics are not recommended for bronchiolitis as it is a viral disease unless
and until it is corss-infected with pneumonia bacteria. The direct care givers of Bree like her
parents are also required to adequate precautions like maintenance of proper hand hygiene
and covering of nose in order spread the chances of cross infection as bronchiolitis is a
communicable disease. In order to give her supreme comfort, it is best to dress her in light
cotton garments and her diet plan must include clear fluid intake through mouth. Excessive
dehydration indicates increased severity of the disease leading to difficulty in swallowing and
thus might require intra venous administration of fluid (Ralston et al., 2014).

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Normal breathing is regular, effortless and involuntary process and the rate of
breathing of child is higher than normal adults (O’Brien et al., 2018). In order to access
breathing of Bree, the care giver is required to count the number of times Bree is inhaling and
exhaling during the tenure of 1 minute. The normal breathing rate of a child is 22 to 28
breaths per minute. Since Bree has cough and runny nose, her breathing will be laboured.
Further accumulation of cough as evident from expiratory wheeze might cause cessation of
breathing. The effect of laboured breathing or coughing over Bree must be strictly monitored.
The nature of sputum must also be record in order to denote the severity of disease. Proper
semi-fowler can be noted in order to provide relief from obstructive breathing. Suction
might also be important in order to clear the mucus of pulmonary airways. Immediate actions
are required to be undertaken if the obstructions is at larynx or trachea as such lockage may
increase fatal treats as a result of asphyxia (O’Brien et al., 2018). External supply of oxygen
must be given in case the oxygen saturation drops below 90 (O’Brien et al., 2018). Parents
must be educated about the semi-fowler position and steps required to be undertaken to
monitor oxygen saturation.

The Nursing Care Plan for Bree (Breathing)
Assess Plan Implement Evaluate
Assessment of the rate of breathing of Bree Pulse oxy-metry to assess the rate of
breathing rate (Ricci et al., 2015)
Installation of pulse oxymetry machine to
monitor rate of breathing rate (Ricci et al.,
2015)
Results from breathing rate
comparison with the normal
breathing rate per hour to ascertain
abnormal breathing condition
Assessment of the amount of mucus
accumulation in the lungs or the pulmonary
airways
Monitoring indicators like wheezing breath
and oozing of mucus through sneezing and
coughing (Ricci et al., 2015)
Monitoring signs and discomfort of Bree
closely like redness of face or fatigue (Ricci
et al., 2015)
Excretion of dilute mucus through
nose (runny nose) indicates mucus
accumulation

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Assessment of oxygen saturation Use of pulse oxymetry to monitor oxygen
saturation and external supply of oxygen
when saturation is low (Meissner, 2016)
Installation of pulse oxymetry machine and
monitoring oxygen saturation (Meissner,
2016)
Increase in the oxygen saturation as
indicated by monitoring machine
Shortness of breath Use of nebulizers or semi-fowler’s position
to ease shortness breathing
Resting child on semi-fowler’s position and
use of nebulizer (Meissner, 2016)
Monitoring child’s comfort while
sleep (Meissner, 2016) via
ascertaining the total duration of
sleep at night

Conclusion
The above mentioned case study analysis is based on two AoL including breathing
and body temperature. Here 18-month old Bree is suffering from bronchiolitis and main
reason for concern is high body temperature and breathlessness. So it will be the duty of the
nurse to monitor the body temperature and respiratory rate in order to design the care plan for
Bree. Apart from this, dehydration, proper administration of medication and maintenance of
sterile condition must be done for the promotion of health and well-being of Bree. In case of
paediatric care plan special attention are required to be undertaken as infants are unable to
express their concerns or discomfort. In relation to Bree it can be said that she should be
given proper comfort like proper sitting position and lying posture, cotton cloths and proper
fluid maintenance. Proper education of the parents or direct care givers must be done to
continuous support and for the reduction of unwanted apprehension and panic attacks. Clear
communication, periodic documentation and monitoring are optimal for promoting patient’s
health and well-being

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